Proctosigmoidoscopic examinations by gastroenterology assistants

Four gastroenterology assistants learned proctosigmoidoscopy by each performing 200 examinations with a physician. The assistants then examined a total of 7557 patients independently. The quality of their examination was assessed by reexamination of about every 10th patient by a physician. The data from all examinations were processed for computer tabulation and periodically reviewed. The patients accepted the examination by the gastroenterology assistant in all but three instances. The time spent by the patient for proctosigmoidoscopy, including preparation and examination, averaged 47 minutes before the assistant program and was reduced to an average of 34 minutes by the gastroenterology assistants. Ten patients had polyps (all smaller than 0.4 cm in diameter) undetected by the gastroenterology assistant but discovered by the physician. All 31 cancers and all of 371 polyps 0.5 cm or larger were discovered by the assistants. We conclude that a satisfactory proctosigmoidoscopy examination can be performed by a properly trained gastroenterology assistant, that it will conserve the physician's time, and that it reduces the waiting time of patients.